To review trends in radiation dose indices from fluoroscopically-guided interventions (FGI) at an NCI-designated cancer center over the past decade. Dose indices including fluoroscopy time (FT), reference air kerma (Ka,r), and kerma area product (PKA) for FGI performed between July 2009 and May 2019 were extracted from an institutional database. Data was evaluated using Python including calculation of derived indices average x-ray field size (PKA/Ka,r) and procedural dose rate (Ka,r/FT). Error checking was performed on data prior to 2016, which was manually entered. Institutional procedure names were mapped to the ACR Common lexicon. Over 34,000 procedures were evaluated in aggregate and, for procedures with 100 or more instances, stratified by procedure. Procedures were classified by complexity on a scale of 1 (least) to 3 (most). Notable events in the institution were included in the evaluation ti [Editor's note: Incomplete sentence as per original submission.] Overall downward trends were observed for all indices with steeper decreases in Ka,r and procedural dose rate observed after implementation of an FGI patient safety program in 2009 and after a move to a new procedural area with new fluoroscopes in 2016. Average field size increased in early 2010 before decreasing steeply until 2016, when it began to increase before decreasing again in late 2017. Similar trends were observed in many individual procedures, with the strongest downward trends observed for nephrostomy exchange (average field size, slope = -5.1 cm2, r = -0.77); nephrostomy placement (log[Ka,r], slope = -0.021, r = -0.63); and nephrostomy exchange (log[procedural dose rate], slope = -0.013 Gy/s, r = -0.56). The trends depended on procedure complexity. With one exception, average field size decreased strongly for the most complex procedures. Ka,r trended downward for all of the least and most complex procedures, but not for all procedures of intermediate complexity. Procedural dose rate trended downward for all of the most complex procedures but not for all of the least complex procedures. Over the past decade, dose indices for FGI have trended downwards, with stronger trends observed around educational interventions and the installation of new equipment.